Encapsulated Rapamycin for the Treatment of Non-Muscle Invasive Bladder Cancer
This phase II trial studies how well encapsulated rapamycin works in treating patients with bladder cancer. Rapamycin may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. The purpose of this trial is to see if encapsulated rapamycin decreases the risk of cancer coming back (relapse) in patients with non-muscle invasive bladder cancer, and to learn if it helps to improve cognition and physical function without negatively affecting patient-reported outcomes and quality of life.
Inclusion Criteria
- Pathologically (histologically) proven diagnosis of non-muscle invasive (Ta, Tis or T1) bladder cancer within 90 days prior to enrollment
- Be able to give informed consent
- Be age 18 or older
- Patients must not be taking oral glucocorticoids at the time of enrollment or have active, uncontrolled infections
- No other prior non-bladder malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years. Patients with localized prostate cancer who are being followed by an active surveillance program are also eligible
- Patients with T1 disease must have cross-sectional imaging of abdomen/pelvis demonstrating no evidence of nodal involvement or metastatic disease (magnetic resonance imaging [MRI] or computed tomography [CT] scan) within 90 days prior to registration
- Patients with T1 disease must have re-resection confirming =< T1 disease within 90 days prior to registration
- Patients must have had all grossly visible papillary tumors removed within 90 days prior to enrollment or cystoscopy confirming no grossly visible papillary tumors within 90 days prior to enrollment
- Patients must not have received prior intravesical bacillus Calmette-Guerin (BCG)
- Patients must not be pregnant or nursing as the use of intravesical BCG is not recommended during pregnancy. Women/men of reproductive potential must have agreed to use an effective contraceptive method. A woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months. Examples of effective contraception are listed below: * Hormonal contraception * Double barrier method (condom with spermicidal cream, diaphragms with spermicidal cream or condoms with diaphragms) * Intrauterine device * Partner vasectomy In addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation. However, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures. Both male and female patients will be required to disclose an effective contraception method during screening and agree to continue to use that contraception method through the end of their participation in the study
Exclusion Criteria
- Have muscle-invasive or higher (>= T2) bladder cancer
- Unable to give informed consent
- Under 18 years of age
- Taking oral glucocorticoids at the time of enrollment
- Have active, uncontrolled infections
- Presence of another cancer requiring active treatment (except basal cell carcinoma or squamous cell carcinoma of the skin)
- Patients at risk of pregnancy that are unwilling or unable to take effective contraception during the study period or patients that are nursing during study period. Women/men of reproductive potential must have agreed to use an effective contraceptive method or will be considered ineligible for study participation
- Evidence of nodal involvement or metastatic disease within 90 days prior to enrollment
- History of prior intravesical BCG
- History of prior Rapamycin treatment
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT04375813.
PRIMARY OBJECTIVES:
I. Test the hypothesis that encapsulated rapamycin (eRapa) decreases the risk of tumor relapse in patients with non-muscle invasive bladder cancer (NMIBC) without diminishing quality of life.
Ia. Test the hypothesis that eRapa prevents NMIBC relapse.
Ib. Examine effects of eRapa on patient-reported outcomes (PROs).
Ic. Examine eRapa effects on cognitive and physical function measures.
II. Test the hypothesis that eRapa improves immune function in patients with cancer.
IIa. Define and validate the range of effects of eRapa on immune parameters in humans that we found to change with age and with mammalian target of rapamycin (mTOR) inhibition in preliminary studies.
IIb. Test the hypothesis that eRapa boosts antigen-specific immunity in bladder cancer (BC) patients.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive encapsulated rapamycin orally (PO) once daily (QD) Monday through Friday for 1 year in the absence of disease progression or unacceptable toxicity. Patients also undergo tissue biopsy, cystoscopy, and biospecimen collection throughout the study.
ARM II: Patients receive placebo PO QD Monday through Friday for 1 year in the absence of disease progression. Patients also undergo tissue biopsy, cystoscopy, and biospecimen collection throughout the study.
Patients are followed up every 3 months for 2 years and every 6 months for 2 years, and then periodically for up to 5 years after enrollment.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationCancer Therapy and Research Center at The UT Health Science Center at San Antonio
Principal InvestigatorRobert Scott Svatek
- Primary IDCTMS 20-0043
- Secondary IDsNCI-2020-05750, ER-B01, HSC20200277XT, STUDY00001422
- ClinicalTrials.gov IDNCT04375813